⋆ How prepared are midwives to provide high-dependency care?: A study exploring midwives' experiences when caring for highly dependent women on delivery suite

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Abstract

Background and aim of study:

This single centre descriptive study focuses upon the provision of obstetric high-dependency care (HDC) within a maternity unit in the north-west of England and asks the question: ‘How prepared are midwives to provide high-dependency care?’. It aims to describe the experiences of midwives who have provided such care within the last two years, corresponding with the hospital's amalgamation with another local hospital, resulting in a subsequent increase in staff's exposure to critically ill women.

Sample:

Purposive sampling of a stratified group totalling ten midwives was chosen using a short questionnaire to determine suitability for inclusion. Participants included direct- and non-direct-entry G and E/F grades who had provided HDC within the first 24 hours of a woman's admission to delivery suite.

Data collection:

This qualitative study utilised a quantitative design to elicit qualitative data collected through the use of structured interviews covering five categories: qualification/background, situation/case, training/education, staffing/skill-mix and service structure.

Data analysis:

The data obtained were analysed using thematic content analysis which allowed for understanding of the participants' experiences by identifying the core and subsidiary processes influencing them.

Findings:

Three midwives had given acute emergency care while nursing. This equipped them with the necessary skills to provide care to obstetric highdependency patients. Such opportunities were not available to their direct-entry colleagues. None felt competent at the point of qualifying to deliver HDC, an area inadequately covered during training. There was no in-service training or formal assessment of competency once qualified.

Findings:

Staffing levels were thought to be inadequate, affecting quality and safety of care. The current service was considered ad hoc, with the quality of care dependent upon staff experience. There was a lack of standardisation and organisation within all aspects of the service and provision of HDC.

Conclusion and recommendations:

Maternity units and midwives' training programmes have not kept pace with technological advances. Experiences within this study cannot be viewed as generalisable to all maternity units and midwives. However, the literature and findings suggest there are no national standards governing practice. Trusts prioritise and interpret patients' needs and the structure of their care according to their financial constraints. This study recommends areas for improvement in in-service training, competency assessment and midwifery training curricula. Additional improvements include the organisation and provision of care, development of information packs and files, utilisation of care pathways, a separately staffed highdependency area and the creation of a cadre of midwives with a particular interest in HDC. Further research and audit should be undertaken to increase professional awareness in obstetric high-dependency and to gather statistics to determine whether the resource potential is sufficient.

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